Pioneering British surgeons are performing heart-valve surgery via a minute incision in the nipple – sparing patients from a large cut and breaking the breastbone to reach the organ.
Doctors say the new technique could provide an option for people who are otherwise too ill to face traditional surgery, but need the faulty valve repaired before it becomes life-threatening.
Thousands of Britons require an operation every year to repair or replace their mitral valve, which is located in the left-hand side of the heart.
Doctors say the new technique could provide an option for people who are otherwise too ill to face traditional surgery, but need the faulty valve repaired before it becomes life-threatening
Damage to the tiny piece of tissue is a form a heart disease. It is thought it may be caused by age-related wear and tear of the valve, or untreated high blood pressure.
It can also affect adults as young as 20 as part of a rare, connective-tissue disorder.
The heart is divided into two, and each half has two chambers in which blood collects.
The lower chambers are known as the left and right ventricles, and the upper ones as the left and right atriums. The mitral valve lies between the left ventricle and the left atrium.
In healthy people, the mitral valve allows blood to flow from the upper chamber to the lower chamber, and then closes to stop it being pumped back.
But for various reasons, the valve can start leaking due to strong, string-like cords on the side of it rupturing, causing it not to close properly.
When this happens, blood can flow back up to the upper chambers of the heart and also to the pulmonary veins – those that carry oxygenated blood from the lungs to the heart.
This means the heart has to work harder to pump oxygenated blood around the body, causing breathlessness. Over time, it can lead to heart failure.
Thousands of Britons require an operation every year to repair or replace their mitral valve, which is located in the left-hand side of the heart. File photo
Traditionally, a damaged valve has been treated with a sternotomy, a procedure during which a 5in to 6in incision is made to break the breastbone and reach the heart. But this involves a long recovery period and some patients are too unwell to tolerate it, especially if they are elderly or have a weakened immune system.
The new approach, known as periareolar, was developed in Brazil and introduced into the UK by Joseph Zacharias, consultant cardiothoracic surgeon at Blackpool Victoria Hospital. While a sternotomy can take up to three months to heal, patients undergoing the new, less invasive treatment can go home after just three or four days.
‘For most people this works very well – they can drive, lift and recover quickly,’ says Mr Zacharias.
The surgeon makes a 1in incision, inserts a tube and then threads a tiny 3D camera through the tube to get images of the area around the valve.
The ruptured cords are replaced with threads made from medical fabric, which are then anchored to the left ventricle.
A small ring is placed around the mitral valve, securing it in place so that it will close properly.
A trial is now under way to compare the technique with open-heart surgery. Called the UK Mini Mitral trial, it is recruiting 400 patients who have been referred by their surgeon or cardiologist for mitral valve repair surgery.
The procedure can also be employed to repair the tricuspid valve, which controls blood flow between the right atrium and right ventricle, and to treat people with atrial fibrillation.
The operation is effective, too, for repairing holes in the heart and removing tumours in the atrium.
MAUREEN Dyer, 75, a retired retail manager from Blackpool, was first diagnosed with atrial fibrillation (an irregular heartbeat) by her GP in March 2016, following a prolonged period of breathlessness after walking.
Doctors suspected that a faulty valve was causing blood to leak towards Maureen’s pulmonary veins – and pressure from the escaped blood can trigger an electrical signal that causes the heart to beat irregularly.
She was referred to Blackpool Victoria Hospital, where doctors detected two additional problems – both her mitral valve and tricuspid valve were floppy and damaged. Maureen underwent periareolar surgery to repair both valves earlier this month and says the results have already been life-changing.
‘The difference is extraordinary – I’m swimming again, and taking long walks along the promenade,’ she says.
‘Before the operation, I couldn’t walk very far from the car without getting too tired.
‘I felt a bit breathless in the first few days after the surgery – and I’ve got the tiniest of scars around my right nipple, but it really doesn’t bother me.
‘It’s only been two weeks but I’m already full of energy again, which is fantastic.’